Annals of Oncology 2006 17(10):1473; doi:10.1093/annonc/mdl356
© 2006 European Society for Medical Oncology
in this issue
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Sequential versus combination chemotherapy with capecitabine, irinotecan and oxaliplatin in advanced colorectal cancer
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Several studies in patients with advanced colorectal cancer
have shown a statistically significant benefit in overall survival
(OS) for the combination of irinotecan and 5-fluorouracil (5-FU)
over treatment with 5-FU alone, and the combination of oxaliplatin
with infusional 5-FU was shown to be superior to irinotecan
plus bolus 5-FU. Nevertheless, salvage treatment was not a prospective
part of these studies, and the suboptimal use of effective salvage
treatment in the control arms has very likely influenced outcomes.
Therefore, it has not been unequivocally shown that combination
treatment is superior compared with the sequential use of these
drugs, which may be relevant since combination treatment is
likely to be accompanied with more toxicity. In this issue,
Koopman et al. present the results of an interim safety analysis
of the sequential versus combined use of capecitabine, irinotecan
and oxaliplatin in patients with advanced colorectal cancer.
These authors report that both treatment arms had an acceptable
safety profile and suggest that the results on survival will
be the major determinant for the selection of either strategy.
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Melanoma micrometastases in sentinel nodes
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Sentinel lymph node status has been demonstrated to be the most
powerful prognostic value for survival of patients with primary
melanoma. Most patients with a positive sentinel node undergo
completion lymph node dissection (CLND) with
10–33% of
the non-sentinel nodes in the specimen containing further metastases.
In this issue, van Akkooi presents the results of a study that
aimed to analyze if any patient and/or tumor characteristics,
sentinel node tumor burden or the location of the metastasis
in the sentinel node, might be prognostic for additional non-sentinel
node positivity, disease-free survival and OS. An attempt was
made to identify patients who could be spared the morbidity
of a CLND, without compromising their survival chances. These
authors suggest that patients with sub-micrometastases (<0.1
mm) in the sentinel node may be judged as sentinel node negative,
as non-stage III and are highly unlikely to benefit from CLND.
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Follicular lymphoma international prognostic index and histological subtype in predicting histological transformation in follicular lymphoma
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Follicular lymphoma is characterized by an indolent clinical
course, with a relatively long survival, but with a continuous
pattern of relapses, resulting in a currently incurable disease.
Moreover, histological transformation into high-grade lymphoma
can be observed in an important proportion of patients and is
associated with a progressive clinical course, poor response
to treatment and short survival. Prognostic studies on histological
transformation are, however, relatively rare. In this issue,
Giné et al. report the results of a study that aimed
to analyze incidence and risk factors for histological transformation
in a large series of follicular lymphoma patients. These authors
report that of 276 patients studied, 30 (11%) presented histological
transformation after a median follow-up of 6.5 years, with all
corresponding to diffuse large-B-cell lymphoma. Of the variables
considered in the study, the follicular lymphoma international
prognostic index and histology were found to be the most important
in predicting histological transformation.
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Cardiac follow-up in bone tumor survivors
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The incidence of heart failure in anthracycline-treated cancer
survivors has been found at up to 5%. Subclinical abnormalities
in systolic and diastolic function and autonomic dysfunction
may, however, be even more frequent. The natural course of these
subclinical abnormalities remains largely unknown and it is
unclear whether or not progressive cardiac deterioration has
to be anticipated. Longitudinal studies of cardiac function
in long-term childhood cancer survivors are scarce and frequently
concern a median follow-up of <13 years. In this issue,
Brouwer et al.
report the results of a study that assessed cardiac function
in 22 doxorubicin-treated long-term survivors of a malignant
bone tumor at median 22 (range 15–27.5) years after treatment.
The results are compared with those of earlier assessments at
9 years (1992) and 14 years (1997) after treatment. These authors
conclude that 22 years after doxorubicin treatment, bone tumor
survivors show progressive cardiac dysfunction.
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Quote
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"But dear readers, you must think, at least a little. It helps."
Sound advice from Yevgeny Zamyatin's We.
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